Sunday, 26 June 2005

How someone understands and responds to their illness can influence whether or not they do all that is medically necessary to protect their health. Judith Moskowitz and Judith Wrubel at the University of California conducted bimonthly interviews with 57 HIV-positive gay men over two years. They wanted to explore the different ways these men responded to their illness, how they coped and the emotions they experienced.

They asked the men to tell them about the most stressful HIV-related event they had experienced in the previous week, and about something meaningful they’d done or that had happened, which made them feel good. The kind of events they talked about, and their reactions, were all coded and patterns were looked for.

Six distinct patterns of coping emerged from the interviews. Six of the men were ‘future focused’, they dwelled on the fact their disease would ultimately kill them, and strove to avoid negative emotions associated with HIV. Seven of the men were ‘detached’: “rather than having to manage negative emotions, the men in this group appeared not to experience negative emotions in the first place”, the researchers said. Thirteen of the men were preoccupied with anxiety about the stigma attached to HIV, yet ironically they stigmatised other people with HIV/AIDS, believing they should avoid going out in public if their symptoms were visible. Eleven of the men were ‘outward focused’, they sought social support more than any other group and were mostly preoccupied with the health and happiness of their friends. Thirteen of the men strove to avoid negative thoughts about their illness, yet they were preoccupied by it, and they were classified as ‘avoid/aware’. Finally, seven of the men began by fitting one of the patterns already described, but switched to another pattern over the course of the study, a change the researchers attributed to their deteriorating health. All but one changed their coping style to fit the ‘outward focus’ pattern.

A person’s approach to their illness influenced how much medical help they sought. The ‘detached’, ‘stigma’ and ‘outward focus’ men all looked after their health carefully, whereas the ‘future focused’ and ‘aware/avoid’ men did not. Moreover, whereas at the study start there were no health differences between men who would be allocated to the different groups, after two years, the men who changed coping style were the most ill and those in the ‘detached’ group were the healthiest. “Different types of intervention are required depending on the meaning of HIV for the individual”, the researchers concluded. “…health care providers should take into account an individual’s way of appraising an illness and tailor their interactions with their patients accordingly”.
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